1. A newly admitted client required seclusion immediately on entering the inpatient unit.
His assessment was incomplete, and medical orders had been written. Immediately after
secluding the client, the priority action of the nurse should be to?
- Notify the physician and obtain an order for seclusion
2. A crisis team is working to admit a violent client who has been both medicated and
physically restrained. Which statement made to the client is the best example of team
function?
- The team leader tells the client “I believe you're feeling very frightened right now.
We can allow you to walk to the unit if you are willing to cooperate.”
3. A client diagnosed with bipolar 1 disorder manic episode refuses to take lithium
carbonate bc od excessive weight gain. In order to increase adherence which medication
should a nurse anticipate that a pysch nurse practitioner may prescribe?
- Valporic acid
4. After a client has displayed anger and aggression, the nurse should assess the client’s
____ to prevent future aggression acts? (select all that apply)
- Feelings
- Thoughts
5. The client has been diagnosed with major depressive disorder. The indicators the nurse
would fine useful for evaluation of outcomes relating to the clients sleep improvement
include (Select all that apply)
- Fewer awakenings
- Ability to resume sleep after awakening
- Decreased time falling asleep
6. A nursing intervention needed to help with bipolar disorder accomplish a key outcome of
achieving a stable lithium level would include teaching the client.
- To take the drug daily w/o skipping doses
7. The nurse is caring for a client in the outpatient setting who has been diagnosed with
depressive disorder. Before the client is given a prescription for a tricyclic antidepressant,
it is important for the nurse to assess the client for risk factors including
- Suicide
8. As a home care nurse, you receive a call from a family member of one of your clients.
Your client has COPD and has been having greater difficulty. You saw the client two days
, ago, and the client seemed sad. When you asked the client about his feelings, he told you
he had felt "down, but it was improving. The client's wife tells you that she found her
husband holding a whole bottle of pills in his hand and taking several of the pills. He
washed the pills down with alcohol. Based on the SAD PERSONS score the clinical
action will be to?
- Closely follow up, consider hospitalization
9. A client diagnosed with major depressive episodes hears voices commanding self-harm.
The nurse’s priority intervention at this time is to ______.
- Place the client on one -to-one observation while continuing to monitor suicidal
ideations.
10. The plan of care for a client with anger includes behavioral interventions. What
intervention would the nurse be likely to implement?
- Anger management
11. A nursing instructor is discussing various challenges in the treatment of clients diagnosed
with bipolar disorder. Which student statement demonstrates an understanding of the
most critical challenge in the care of these clients?
- Treatment is compromised when clients choose not to take their medications.
12. A nurse is working with a potentially violent client in a community clinic. What would
the nurse implement to minimize personal risk?
- Staying close to a door
13. A client who has been diagnosed with major depressive disorder. After treatment with
fluoxetine, the client exhibits pressured speech and flight of ideas. Based on the symptom
change, which physician action would the nurse anticipate?
- Discontinue the fluoxetine and rethink the clients diagnosis
14. A client is hospitalized on a pysch unit secondary to a suicide attempt. He has been
diagnosed with depression. He has been consistently depressed. Which of the following
observations would signal the nurse that the clients suicidal risk has worsened?
- The client says he feels better and he interacts more with other clients
15. Which response best reflects appropriate assertiveness by a nurse when approached by a
client who demands medication immediately?
His assessment was incomplete, and medical orders had been written. Immediately after
secluding the client, the priority action of the nurse should be to?
- Notify the physician and obtain an order for seclusion
2. A crisis team is working to admit a violent client who has been both medicated and
physically restrained. Which statement made to the client is the best example of team
function?
- The team leader tells the client “I believe you're feeling very frightened right now.
We can allow you to walk to the unit if you are willing to cooperate.”
3. A client diagnosed with bipolar 1 disorder manic episode refuses to take lithium
carbonate bc od excessive weight gain. In order to increase adherence which medication
should a nurse anticipate that a pysch nurse practitioner may prescribe?
- Valporic acid
4. After a client has displayed anger and aggression, the nurse should assess the client’s
____ to prevent future aggression acts? (select all that apply)
- Feelings
- Thoughts
5. The client has been diagnosed with major depressive disorder. The indicators the nurse
would fine useful for evaluation of outcomes relating to the clients sleep improvement
include (Select all that apply)
- Fewer awakenings
- Ability to resume sleep after awakening
- Decreased time falling asleep
6. A nursing intervention needed to help with bipolar disorder accomplish a key outcome of
achieving a stable lithium level would include teaching the client.
- To take the drug daily w/o skipping doses
7. The nurse is caring for a client in the outpatient setting who has been diagnosed with
depressive disorder. Before the client is given a prescription for a tricyclic antidepressant,
it is important for the nurse to assess the client for risk factors including
- Suicide
8. As a home care nurse, you receive a call from a family member of one of your clients.
Your client has COPD and has been having greater difficulty. You saw the client two days
, ago, and the client seemed sad. When you asked the client about his feelings, he told you
he had felt "down, but it was improving. The client's wife tells you that she found her
husband holding a whole bottle of pills in his hand and taking several of the pills. He
washed the pills down with alcohol. Based on the SAD PERSONS score the clinical
action will be to?
- Closely follow up, consider hospitalization
9. A client diagnosed with major depressive episodes hears voices commanding self-harm.
The nurse’s priority intervention at this time is to ______.
- Place the client on one -to-one observation while continuing to monitor suicidal
ideations.
10. The plan of care for a client with anger includes behavioral interventions. What
intervention would the nurse be likely to implement?
- Anger management
11. A nursing instructor is discussing various challenges in the treatment of clients diagnosed
with bipolar disorder. Which student statement demonstrates an understanding of the
most critical challenge in the care of these clients?
- Treatment is compromised when clients choose not to take their medications.
12. A nurse is working with a potentially violent client in a community clinic. What would
the nurse implement to minimize personal risk?
- Staying close to a door
13. A client who has been diagnosed with major depressive disorder. After treatment with
fluoxetine, the client exhibits pressured speech and flight of ideas. Based on the symptom
change, which physician action would the nurse anticipate?
- Discontinue the fluoxetine and rethink the clients diagnosis
14. A client is hospitalized on a pysch unit secondary to a suicide attempt. He has been
diagnosed with depression. He has been consistently depressed. Which of the following
observations would signal the nurse that the clients suicidal risk has worsened?
- The client says he feels better and he interacts more with other clients
15. Which response best reflects appropriate assertiveness by a nurse when approached by a
client who demands medication immediately?
